Retiring NC Medicaid director Dave Richard earned reputation for providing stability

In a state government increasingly known for its partisanship, Medicaid director Dave Richard has been an authority figure both Democrats and Republicans have trusted to have North Carolinians' best interest at heart.

Richard announced last week his plans to retire after nearly eight years as deputy secretary of the N.C. Division of Medical Assistance on Feb. 28.

Richard could not be reached for comment on his retirement decision.

Richard will step down after a 41-year career in public health, also serving as executive director of The Arc of N.C. and the state's top official for behavioral health services for two years before become deputy secretary.

He served in the top Medicaid leadership role in both the McCrory and Cooper administrations, being a stabilizing presence as the state transitioned through four health secretaries.

During his time, the state Medicaid program grew from 1.9 million to 2.9 million beneficiaries and from a $14 billion to $21 billion program.

"Few have done more to improve the health and well-being of North Carolinians," the N.C. Department of Health and Human Services said in a statement.

"Dave made it his focus to improve our mental health system, increase community-based supports for those with disabilities, and partner with providers.

"In Medicaid, he bolstered the financial stability of the program and worked closely with the General Assembly to shape the vision for managed care. Dave leaves North Carolina Medicaid stable and strong with a robust team of leaders to carry the torch."

Rep. Donny Lambeth, R-Forsyth, and the chief House health-care reform proponent, worked closely with Richard on pivotal Medicaid transformation reform legislation.

"Dave has been a dedicated advocate for many Medicaid issues, including expanding care to citizens who need care," Lambeth said.

"He has worked tirelessly with both parties and has been consistent in his advocacy. He is one of the longest serving state Medicaid directors in the nation, so his experience and history with this program will be missed.

"I have found him to be fair in his relationships with legislators, as well as a variety of advocacy groups in North Carolina."

Democratic Gov. Roy Cooper said Richard "has done good work managing a vital and challenging health insurance program that does so much good for North Carolinians.

"I expect a smooth transition that will continue the efforts to provide health care for those in need and to expand Medicaid as soon as possible."

Tumultuous times

Richard took over in May 2015 during the tumultuous tenure of Dr. Aldona Wos as state health secretary, who was known for being a lightning rod for criticism and praise while wrestling with DHHS inefficiencies.

At that time, the state Medicaid program was running annual deficits that totaled in the billions of dollars in the early 2010s, much to the chagrin of increasingly irritated legislative budget writers asked to find money to make the program whole by the end of a fiscal year.

Legislators from both parties criticized DHHS and Wos for similar budget, financial and operational concerns.

Six state audits from January 2013 through May 2015 raised questions about DHHS' ability to efficiently operate elements of the state Medicaid program in an efficient, transparent and timely manner.

Perhaps Richard's accomplishment was helping shepherd Republican Medicaid transformation reform legislation into law, convincing both parties to embrace a you don't get all you want, but you get what vulnerable North Carolinians need perspective.

For five years, Richard worked and cajoled legislative health care proponents from both parties to embrace and pass a series of Medicaid managed care reform bills.

Those efforts culminated in July 2020 when Democratic Gov. Roy Cooper signed Republican-sponsored legislation that provided pivotal start-up funds for what could become a $30 billion Medicaid reform initiative - among the largest vendor contracts awarded in state history.

The managed care reform was a coverage game-changer for an estimated 1.6 million to 1.8 million North Carolinians.

It allows them to choose between four statewide prepaid health plans (PHP) for their physical and behavioral health coverage, or have a plan selected for them.

Richard said the transformation insures that Medicaid recipients will continue to see the same medical provider if available through the PHP, and that providers will get paid.

The transformation legislative and other reform bills - some bipartisan, some Republican sponsored - has led to the program staying in the black the past six state fiscal years.

Medicaid expansion

However, Richard will retire unable to get North Carolina to the finish line of an expansion initiative that could benefit between 450,000 and 650,000 residents.

Senate and House Republicans remain at an impasse over how to expand.

Senate leader Phil Berger, R-Rockingham, prefers to include several overall health care reform elements - most notably certificate-of-need reform to allow for more competition for hospitals - and House speaker Tim Moore, R-Cleveland, backing legislation without most of those reforms.

Cooper has indicated a willingness to compromise on either bill in order to make North Carolina the 39th state to expand its Medicaid program.

"Dave Richard has been a champion for others throughout his distinguished career," said Steve Lawler, president and chief executive of the N.C. Healthcare Association.

"As deputy secretary, Dave has been a roll-up-your-sleeves leader, committed to working with all to ensure that those under his charge and care had access to the very best health care and services.

"He will be missed and we wish him well in all his future endeavors."

NCHA added that it remains commitment "to advocating for Medicaid expansion and will work with the next deputy secretary."

Richard will also not be there for the launch of another key Medicaid transformation initiative in North Carolina - tailored plans for behavioral health recipients.

After what was set to be a July 1, 2022, launch, it has been delayed twice, first to Dec. 1, 2022, and now to April 1.

Individuals who need certain services to address a serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual or developmental disability, or traumatic brain injury may be eligible to enroll in a tailored plan.

DHHS said in July 2021 that tailored plans could serve about 200,000 North Carolinians.

Sen. Joyce Krawiec, R-Forsyth, and a leading Senate healthcare proponent, said Richard's retirement "is a big loss for us and for DHHS."

"There is no one who has more knowledge of our Healthcare system in North Carolina than Dave, and his shoes will be hard to fill.

"As chairwoman of Health Care and Health Appropriations in the Senate, I have enjoyed working with him through the years and I will personally miss him."

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